Medical Primary Care Providers Research Articles

Characterizing Medical Providers for Jail Inmates in New York State

People who are incarcerated exhibit high rates of disease, but data evaluating the delivery of medical services to inmates are sparse, particularly for jail settings. We sought to characterize the primary medical care providers for county jail inmates in New York State. From 2007 through 2009, we collected data on types of medical care providers for jail inmates in all New York State counties. We obtained data from state monitoring programs and e-mail questionnaires sent to county departments of health. In counties outside New York City (n = 57), jail medical care was delivered by local providers in 40 counties (70%), correctional medical corporations in 8 counties (14%), and public providers in 9 counties (16%). In New York City, 90% of inmates received medical care from a correctional medical corporation. Larger, urban jails, with a greater proportion of Black and Hispanic inmates, tended to use public hospitals or correctional medical corporations as health care vendors. Jail medical services in New York State were heterogeneous and decentralized, provided mostly by local physician practices and correctional medical corporations. There was limited state oversight and coordination of county jail medical care.

Application of the Theory of Planned Behavior to Nurse Practitioners' Understanding of the Periodontal Disease–Systemic Link

Mounting evidence supports a connection between periodontal disease and coronary heart disease, ischemic stroke, and diabetes. This theoretically grounded study examines the knowledge, attitudes, and screening and referral behaviors of primary care nurse practitioners (NPs) in relation to the periodontal disease-systemic link. A questionnaire based on the theory of planned behavior was administered to 200 primary medical care providers, mostly NPs, to determine their practice behaviors, attitudes, opinions, and knowledge regarding the periodontal disease-systemic link. A total of 137 partially and fully complete questionnaires were used for data analyses. Data were analyzed for the reported frequency of screening for periodontal disease and the knowledge of the relationship between periodontal and systemic disease. Oblimin rotation was used to explore the underlying factor structure of 10 practice-behavior items. Bivariate analyses were conducted to determine which factor subscales and demographic characteristics were significantly associated with screening and referral behaviors. Twenty-two percent of the respondents reported that they always or routinely screened patients for periodontal disease. When providers felt good about their training and continuing education (attitude), they were significantly more likely to screen patients for periodontal disease. If providers believed it was within their scope of practice (social norm) to screen for periodontal disease, and they had control over the establishment of office protocols (control), the likelihood of screening for periodontal disease increased. Professional and social norms, the perceived control over one's practice site, and reimbursement were significantly related to NPs engaging in periodontal screening and the subsequent referral for care. These results support the importance of interprofessional and collaborative education between medicine/nursing and dentistry.

Pay-for-performance in dentistry: what we know.

Little is known about the effect of a pay-for-performance system (P4P) on primary medical care providers and even less is known about its potential impact in dentistry. Based on the growing acceptance of performance-based reimbursements in medicine and the dissemination of innovative technologies, structures, and processes of care from medical to dental services, it is likely that the dental profession will face performance-based payments in the not-too-distant future. In this paper, we present the current experience of P4P in primary medical care that has relevance to dentistry and discuss the dental performance-based programs to date. Taking into consideration these lessons, the structure of dental service delivery in the United States, and the paucity of evidence-based quality indicators in dentistry, we provide several guidelines for the design of P4P pilot programs for dental services. We conclude that large-scale implementation of P4P for dentistry may not be a realistic option before significant progress is achieved in quality of dental care indicators.

Opinions of Early Head Start Staff about the Provision of Preventive Dental Services by Primary Medical Care Providers

This study investigates the opinions of the Early Head Start (EHS) staff about physicians and nurses providing preventive dental services for children in EHS. A cross-sectional survey was undertaken of the EHS staff having contact with families in EHS programs in North Carolina (NC). A self-completed questionnaire solicited their opinions (agree, disagree, don't know) about whether physicians and nurses can "provide preventive dental care" and "identify dental problems" in infants and toddlers. Staff knowledge (four items) and attitudes (five items) were tested for their association with whether staff had an opinion (agree/disagree versus don't know) and if so, what that opinion was (agree versus disagree) using the generalized estimating equation method. Questionnaires were completed by 476 staff (98 percent response) in 18 programs (100 percent response). The majority of staff believed that physicians and nurses can provide preventive dental services (66 percent) and identify dental problems (52 percent). Staff placing importance on ensuring access to dental care and who were knowledgeable about fluoride uses were more likely to have an opinion. Among staff with an opinion, those familiar with the NC program where these services are provided in medical offices were more likely to agree that physicians and nurses can provide preventive services and identify problems. Although the opinions of the majority of the EHS staff are not a barrier to using primary medical care providers to deliver preventive dental care, education is needed for staff who are unfamiliar with this approach.

Rear-Facing Car Safety Seats: Getting the Message Right

Information learned during medical training changes frequently with advances in nearly every field of medicine. Now we are asked to learn new advice to give parents and caregivers of infants and young children regarding the safest way for them to ride in a car. Child fatalities and injuries in motor vehicles have been significantly reduced since initiation of occupant-protection measures in the 1970s.1 The combined efforts of the counseling of primary medical care providers, the education and research provided by the National Highway Traffic Safety Administration, the car safety seat manufacturers, and many research facilities, and the support of child passenger safety advocates across the country have been largely responsible for these results. Many challenges remain as we strive to continue to reduce the rates of injury to children on our nation's highways. It is critical to realize that, despite marked improvement in rates of restraint in all age groups, over half of children killed are improperly restrained or unrestrained. Our first priority must be to ensure that every child is restrained appropriately for his or her age and size for every trip in a car. Helping parents make the best decisions for selection and proper use of car safety seats and seat belts is very important. Continual evolution of knowledge, safety information, and changes in car safety seat designs make this task … Address correspondence to Marilyn J. Bull, MD, 4747 N Meridian St, Indianapolis, IN 46208. E-mail: mbull{at}iupui.edu

Accuracy of primary care medical providers' understanding of the FDA black box warning label for antidepressants

Accuracy of primary care medical providers' understanding of the FDA black box warning label for antidepressants

Dental Screening and Referral of Young Children by Pediatric Primary Care Providers

Dental Screening and Referral of Young Children by Pediatric Primary Care Providers

Paradigm shifts in clinical trials enabled by information technology.

The use of the world wide web for clinical trials changes the processes of performing clinical research in several fundamental ways. Greatly improved security, monitoring capability, and accuracy and timeliness of study conduct can be achieved while lowering cost. Data quality is enhanced while co-ordinating centre effort is reduced. The web provides a natural environment for linking the various components of clinical research, leading to new levels of simplicity and efficiency. It also enhances opportunities for recruitment of study investigators and patients. Other information technology tools and databases can be used to assist in this regard as well. Web-based trials change the relationship of the investigator site to the study and the site to the co-ordinating centre. Different roles and responsibilities lead to simplified processes and more and higher quality data. Many standard co-ordinating centre activities, such as randomization, protocol implementation and amending, document tracking, adverse event reporting, site monitoring, report generation and data analysis are all fundamentally changed in a web-based trial. Opportunities are enhanced to identify potential investigators and support their successful study conduct. As the role of investigator sites is changed in web-based research, more primary care medical providers can be attracted to research, providing more typical patients to studies than those sometimes available through more traditional research sites, especially those at academic study sites. Other activities can now be co-ordinated electronically with the advent of the web. The Institutional Review Board (IRB) can use online tools to control investigator participation, resulting in improved study efficiency and patient safety. A web-based research pharmacy provides tremendous efficiencies in managing and distributing study medications. Financial payments to the sites can be performed and recorded electronically, or even administered based on timeliness and quality of the data. Our early experience with web-based trials indicates that there can be tremendous gains in study efficiency and accuracy by restructuring processes, roles and responsibilities through a comprehensive centralized, web-based trial. The future appears bright for web-based clinical trials.

Surgeons' attitudes toward HIV/AIDS in Turkey

Currently HIV/AIDS is one of the most difficult challenges for health care professionals. As primary medical care providers, attitudes of the physicians towards HIV/AIDS are of utmost significance. The aim of this research is to determine the attitudes of the surgeons towards HIV/AIDS in their working environment. Data were collected from a self-administered questionnaire given to 128 surgeons. Results revealed that gender, age and professional experience are not significant. This study demonstrated that doctors are worried about contracting HIV/AIDS from the patients. In some circumstances doctors' attitudes, are not clear which may lead to some ethical problems. It is concluded that doctors overestimate the risks and they need special education about HIV/AIDS, as well as professional help to handle their attitudes toward HIV/AIDS.

PTSD among Bosnian refugees: a survey of providers' knowledge, attitudes and service patterns.

The objective of this study was to investigate providers' knowledge, attitudes and service provision patterns for Bosnian refugees with PTSD and to consider the overall implications for trauma-related mental health services. A survey instrument was developed and administered to 30 randomly selected service providers working with Bosnian refugees in Chicago. This sample includes primary medical care providers (n = 7), community social service providers (n = 12), and mental health service providers (n = 11). Results showed that knowledge about PTSD is highest in mental health service providers, as is amount of previous training and education about PTSD. Less than half of all providers systematically assess for PTSD, and standardized instruments for PTSD are rarely used. The top three overall recommendations for services were ranked as: 1. Psychotherapy; 2. No intervention; 3. Psychiatric evaluation. In general, less than half of providers hold attitudes toward refugees as suffering from illnesses or mental disorders, or that "something" is wrong with them. Likewise, only half of the providers reported providing education to refugees and their families about the possible mental health consequences of trauma. In conclusion, assessment, intervention and educational activities of providers are not consistent with literature documenting that PTSD is highly prevalent in refugee populations. New training programs, model development, and research initiatives are needed to address the needs of refugees.

DENTAL CARIES: An Infectious and Transmissible Disease

Of the infectious diseases that affect humans, dental caries may be the most prevalent. Pediatric primary medical care providers are usually the first health care providers to examine the oral cavity of a child and so need to be able to recognize suspicious dental lesions. This article provides information on recognizing caries and reviews the epidemiology, pathogenesis, and treatment of caries and odontogenic infections.

Mental health services among ambulatory patients with human immunodeficiency syndrome infections.

A retrospective study of 463 medical and social service records of patients with AIDS, ARC and minimally symptomatic individuals was conducted to examine mental health services delivered by primary medical care providers. A substantial minority of patients in all three groups had a psychiatric diagnosis and were prescribed psychotropic medications. Recognition of psychiatric complications varied by ethnicity and socioeconomic status.

Attitudes to education in Sri Lankan general practice.

There has recently been increased recognition of the importance of continued learning for all providers of primary medical care. A variety of methods, as well as disappointment with their uptake, have been described. This paper reports part of a study to investigate the role of general practitioners in the provision of primary health care in Sri Lanka. Reading habits and attendance at medical meetings and courses are determined. The number of positive characteristics of good primary care are shown in those who have greater involvement in continuing education. Suggestions are made for the future development of continuing medical education (CME) in Sri Lanka in order to define and meet doctors' learning needs.Experience is the child of thought and thought the child of action. We cannot learn men from books. (Disraeli, 1826).

The teaching hospital and primary care.

Abstract Hospitals have become major providers of primary medical care by default rather than design because of the decreasing availability of primary physicians in community practice. In 1972, Bet...

The teaching hospital and primary care. Closing down the clinics.

Hospitals have become major providers of primary medical care by default rather than design because of the decreasing availability of primary physicians in community practice. In 1972, Beth Israel Hospital in Boston closed its traditional general clincs and estblished a primary-care group practice--Beth Israel Ambulatory Care. The practice is staffed by teams of full-time salaried physicians, other health professionals and paraprofessionals, house staff and medical students. More than 25 per cent of patient visits are managed by nonphysicians. Subspecialty clinics have been relieved of primary-care case loads and limited to referral and consultative functions. In 1973-74, the cost per visit was $20.32. Patient-visit volume in primary care has increased from a figure of 29,144 in 1971-72 to 41,650 in 1973-74. Broken appointments have declined by one third.

The Family Practice Model in Health Education

The American Board of Family Practice was established early in 1969. Family practice, as the nation's 20th specialty, was thus formally recognized as having a legitimate place in the health-care system. General practice was not discarded. Rather, the establishment of the American Board of Family Practice constituted a formal request to bring general practice up to date, to standardize its training program at a level equivalent to the other specialties, and to recognize competence and formal training by means of examination and certification. Thoughtful educators and physicians from many disciplines wrote and conferred for a decade in order to make a decision that would be the most appropriate for the consumers as well as the providers of primary medical care. Most any new name would have been fitting to symbolize the upgraded or specialty status of the new general practitioners. The label of family practice was chosen because it carried